DESCRIPTION
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues.

Types of anemia
Anemia due to B12 deficiency Anemia due to foliate deficiency
Anemia due to iron deficiency Anemia of chronic disease
Hemolytic anemia Idiopathic a-plastic anemia
Megaloblastic anemia Pernicious anemia
Secondary aplastic anemia Sickle cell anemia

Causes and risk factors
While many parts of the body help make red blood cells, most of the work is done in the bone marrow. Bone marrow is the soft tissue in the center of bones that helps form blood cells.
Healthy red blood cells last between 90 and 120 days. Parts of your body then remove old blood cells. A hormone called erythropoietin made in your kidneys signals your bone marrow to make more red blood cells.
Hemoglobin is the oxygen-carrying protein inside red blood cells. It gives red blood cells their red color. People with anemia do not have enough hemoglobin.
Possible causes of anemia include:
Certain medications
Chronic diseases such as cancer, ulcerative colitis, or rheumatoid arthritis
Genetics: Some forms of anemia, such as Thalassemia, can be inherited
Kidney failure
Blood loss (for example, from heavy menstrual periods or stomach ulcers)
Poor diet
Pregnancy
Problems with bone marrow such as lymphoma, leukemia, or multiple myeloma
Problems with the immune system that cause the destruction of blood cells (hemolytic anemia)
Surgery to the stomach or intestines that reduces the absorption of iron, vitamin B12, or folic acid
Too little thyroid hormone (underactive thyroid, or hypothyroidism)
Testosterone deficiency

Symptoms
Possible symptoms include:-
1 Chest pain
2 Dizziness or light-headedness (especially when standing up or with activity)
3 Fatigue or lack of energy
4 Headaches
5 Problems concentrating
6 Shortness of breath (especially during exercise)

Treatment
Treatment should be directed at the cause of the anemia, and may include:-
1 Blood transfusions
2 Corticosteroids or other medicines that suppress the immune system
3 Erythropoietin, a medicine that helps your bone marrow make more blood cells
4 Supplements of iron, vitamin B12, folic acid, or other vitamins and minerals.

Fig.1
DESCRPITION
DEFINITION
Nebulization is the process of medication administration via inhalation. It utilizes a nebulizer which transports medications to the lungs by means of mist inhalation.

INDICATION
Nebulization therapy is used to deliver medications along the respiratory tract and is indicated to various respiratory problems and diseases such as:
• Broncho-spasms
• Chest tightness
• Excessive and thick mucus secretions
• Respiratory congestions
• Pneumonia
CONTRAINDICATIONS
In some cases, nebulization is restricted or avoided due to possible untoward results or rather decreased effectiveness such as:
• Patients with unstable and increased blood pressure
• Individuals with cardiac irritability (may result to dysrhythmias)
• Persons with increased pulses
• Unconscious patients (inhalation may be done via mask but the therapeutic effect may be significantly low)
EQUIPMENTS
• Nebulizer and nebulizer connecting tubes
• Compressor oxygen tank
• Mouthpiece/mask
• Respiratory medication to be administered
• Normal saline solution
PROCEDURE
1. Position the patient appropriately, allowing optimal ventilation.
2. Assess and record breath sounds, respiratory status, pulse rate and other significant respiratory functions.
3. Teach patient the proper way of inhalation:
o Slow inhalation through the mouth via the mouthpiece
o Short pause after the inspiration
o Slow and complete exhalation
o Some resting breaths before another deep inhalation
4. Prepare equipments at hand
5. Check doctor’s orders for the medication, prepare thereafter
6. Place the medication in the nebulizer while adding the amount of saline solution ordered
7. Attach the nebulizer to the compressed gas source
8. Attach the connecting tubes and mouthpiece to the nebulizer
9. Turn the machine on (notice the mist produced by the nebulizer)
10. Offer the nebulizer to the patient, offer assistance until he is able to perform proper inhalation (if unable to hold the nebulizer [pediatric/geriatric/special cases], replace the mouthpiece with mask.
COMPLICATIONS
Possible effects and reactions after nebulization therapy are as follows:
• Palpitations
• Tremors
• Tachycardia
• Headache
• Nausea
• Broncho-spasms (too much ventilation may result or exacerbate Broncho-spasms)

• TEACHINGS
As nurses, it is important that we teach the patients the proper way of doing the therapy to facilitate effective results and prevent complications (demonstration is very useful). Emphasize compliance to therapy and to report untoward symptoms immediately for apposite intervention.

Auscultatory gap is the temporary disappearance of sounds normally heard over the brachial artery when the cuff pressure is high and the reappearance of the sounds at a lower level.

Provide excellent clues to the physiological functioning of the body.
• Alterations in body flexion are reflected in the body temp, pulse, respirations and blood pressure.
• These data provide part of the baseline info from which plan of care is developed.
• Any change from normal is considered to be an indication of the person’s state of health.

DESCRIPTION:-
Sir Alexander Fleming discovered penicillin in 1928 from Penicillin notatum. In 1941 penicillin was available for therapeutic use. Penicillins are one of the most important groups of antibiotics. Penicillin is now obtained from the fungus Penicillin chrysogenum for therapeutic use.
MECHANISM OF ACTION:- Beta lactam antibiotics act by inhibiting cell wall synthesis in the bacteria. The rigid cell wall of the bacteria protects the bacteria from lysis. Therefore, cell wall is essential for the survival of bacteria. Peptidoglycon is an important component of the cell wall which gives rigidity to cell wall. The Synthesis of this peptidoglycan requires enzymes called transpeptidases. Beta -Lactam antibiotics inhibit these transpeptidases and thus inhibit the synthesis of peptidoglycon. This results in the formation of bacteria with weak cell wall. Such bacteria undergoes lysis .
CLASSIFICATION:- a. Natural e.g. penicillin
b. Semi-synthetics
NATURAL PENICILLINS :-
Penicillin G (Benzyl Penicillin) :- Anti bacterial spectrum:- Penicillin G has narrow antibacterial spectrum and is effective against gram-positive cocci and bacilli and a few gram negative cocci.
Resistance:- Many Organism like staphylococci produce penicillinase which is a beta –lactamase.It opens the Beta Lactam rings and inactivates penicillin’s.
Penicillin may not bind to the bacteria because of changes in the target proteins. This also leads to resistance.
Pharmacokinetics:- Penicillin G is destroyed by gastric juice, food interferes with its absorption – hence, it is to be given 2 hours after food. It has a short t half life of 30 minutes.
Preparation and Dose:- Penicillin G is mainly given parentrally. Oral penicillin is used only in minor infection.
Adverse effect:- Hypersensitivity:- It is the most common cause of drug allergy.
Jarisc h-Herxheimer Reaction:- When penicillin is injected in a patient with syphilis, there is sudden destruction of spirochetes and release of its lytic products. These triggerers a reaction with fever, myalgia, exacerbation of syphilitics lesions and vascular collapse.